Biomedical subjects
Publications and source records attributed to U Holz.
Eight avulsions of the distal biceps tendon were operatively treated between 1982 and 1985. The operative procedure and results of subsequent investigations are described. The problems of correlation between injury and trauma and its assessment by histological observations are discussed. The clinical results have been good. So we can recommend the operative method according to Platt.
The complex and simple fractures seen in polytrauma patients after initial treatment sometimes show signs of poor setting and non-union with possible unfavourable functional consequences making reconstructive surgery necessary. In this report characteristic posttrauma problems and reconstructive surgery of the proximal femur, the femoral shaft and the distal femur are discussed. Possibilities other than prothesis or joint fusion, especially in the hip or knee joint, should be considered.
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Compound osteosyntheses are in fact mostly intended to effect temporary (i.e. for a limited time) stabilization of pathological fractures, especially of spontaneous fractures in the case of metastasizing tumours. However, in view of the fact that progression of such tumours metastasizing into the skeleton cannot be predicted with reasonable accuracy, it is better to bridge over the spontaneous fracture not only by means of a compound of bone cement and metal plate, but also to see to it--as far as ever possible--that bony healing is induced via grafting of autogenous bone material. If this is not done, prolonged stress on the metal/cement compound may result in fatigue rupture.
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In bone fractures in the lower extremities a high blood loss must be taken into consideration. An adequate blood transfusion should be given before and during diagnostic procedures. Diagnostic measures should proceed quickly and be limited to the necessary treatment. Operative setting of closed fractures can be programmed when conditions are optimal. Immediate setting of open fractures has proven to be valuable not only because the blood loss may be controlled, but also because extensive soft tissue distraction and possible infection can be prevented. The crush-syndrome can be caused by crushing injuries, pluck-out injuries and traumatic amputation and endanger the patient's life.
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In compound fractures, after debridement and stabilisation, primary open wound treatment with synthetic skin substitute is the method of choice. A follow-up examination of 171 second- and third-degree compound fractures between April 1974 and June 1981 showed an infection rate of 18,7% and an osteitis rate of 14,6%. In 23 cases conservative surgery was performed, in 17 cases primary amputation was necessary. In 85% of all cases bone healing was achieved after an average of 5,4 months.
It is shown on the basis of two observations that computed tomography represents a valuable additional means to clarify the diagnosis of congenital and traumatic changes in the pelvis, especially the sacrum and vertebral column. The article explains the differential diagnosis between congenital fissures of the pelvic arch and fractures by means of computed tomography. This is illustrated with the help of x-ray morphologic criteria.
The oblique osteotomy of metatarsale I according to Ludloff allows good and various corrections in hallux valgus deformities. Various modifications of the osteotomy are described. In case of simultaneous osteoarthritis of the metatarsophalangeal joint the additional resection according to Keller-Brandes is recommended.
The results of autogenous bone grafts to reconstruct defects created by fractures, pseudarthrosis, osteotomies and tumor-like lesions were analyzed in 397 cases. In the different fields of indication the grafts were repaired in approximately the same time and incidence. Stabile conditions at the site of defect are of utmost importance. Mostly the grafts were taken from the iliac crest and there the 0.3% incidence of postoperative hematoma is low. For a solid repair of the defect the grafts should not only fill the gap but also bridge the defect from fragment to fragment.
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Physical aspects of load distribution within the femoral head beneath the "Resurfacing-Prosthesis" are analyzed. The cup prosthesis eliminates stress from areas which--according to the bone structure--are weight bearing areas and induces shearing forces within the femoral neck. Tangential forces appear in addition to increasing marginal stress. These unphysiological loadings are amplified in case of varus position of the cup. Biomechanically for the cup prosthesis the term "resurfacing" is not justified.
The indications of an arthrodesis of the knee joint have changed and seem to be rare in a century of total arthroplasty. However, even nowadays the arthrodesis of the knee joint is still carried out with good results in: postinfectious gonarthrosis, irreparable posttraumatic instability, Charcots knee, Neoplastic destructions in special cases, for patients with a severe painful and deforming arthrosis of any reason, which are too young for an arthroplasty and in a century of arthroplasty for all patients after failure of arthroplasty. Within a period of 11 years from 1969-1980, 105 patients underwent an arthrodesis of the knee joint at BG Unfallklinik Tübingen. Indications and technique are given, the value of an individual postoperative care is pointed out.
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